Emergent stent-assisted angioplasty of extracranial internal carotid artery and intracranial stent-based thrombectomy in acute tandem occlusive disease: technical considerations

Abstract

In selected cases of acute ICA occlusion and concomitant major vessel embolic stroke, angioplasty and stenting of the proximal occlusion and stent-based thrombectomy of the intracranial occlusion may be feasible, effective and safe, and provide early neurological improvement. Further experience and prospective studies are warranted.

Emergency carotid artery stenting in patients with acute ischemic stroke due to occlusion or stenosis of the proximal internal carotid artery: a single-center experience

“…Many previous studies have not mentioned the prevalence of CHS. However, the development of intracerebral hemorrhage, the most fatal form of CHS, has been reported for 21 patients in 10 studies,5––9 11–14 16 and symptomatic hemorrhage developed in 10 patients5 6 12 13 16 and was mostly fatal. Thus, conducting intensive post-procedural care such as full monitoring, frequent neurological assessment and strict BP control is important for achieving good clinical outcomes.…”

Emergency Cervical Internal Carotid Artery Stenting in Combination with Intracranial Thrombectomy in Acute Stroke

“…On admission, the median initial NIHSS score was 18 (interquartile range, [15][16][17][18][19][20][21][22]. Two patients (initial NIHSS scores of 4 and 5) were referred for interventional therapy only after fluctuation of symptoms and clinical deterioration.…”

Treatment of Middle Cerebral Artery Occlusion and Internal Carotid Artery Dissection with Combined Mechanical Thrombectomy and Stenting of the Internal Carotid Artery

“…As the combined event of an ICA dissection and thromboembolic occlusion of the MCA is a rare finding, systematic prospective randomized studies dealing with the question of whether systemic intravenous thrombolysis or interventional treatment is the better choice are currently lacking. Nevertheless, some recent reports confirm that combined stent-assisted angioplasty and mechanical thrombectomy in acute tandem occlusions is a safe procedure and should be taken into consideration for treatment if an experienced neuroradiologist is available 11,12 . microguidewire (Stryker) with its tip placed distally in the M2 segment.…”